Male Circumcision and Use of Foreskin Tissues for HIV Prevention in Uganda

项目概要/摘要 医疗男性包皮环切术 (MMC) 可减少男性感染艾滋病毒以及男性和女性的病毒性性传播感染。 然而，许多非洲国家对 MMC 的接受程度低于预期，并且不成比例地被接受。 在年轻、风险较低的男性中。迫切需要将实施科学纳入 定性/定量混合方法研究，以增加对 MMC 的需求，特别是在高等院校中 风险人；使用 MC 设备、任务转移/共享和移动 MMC 提高 MMC 服务的效率 营地；并对覆盖范围和影响进行人口层面的监测。在基础科学层面， 在 MC 期间收集的包皮为研究病毒学、免疫学提供了接触生殖器粘膜的独特途径 以及与艾滋病毒易感性或保护相关的宿主遗传因素，对艾滋病毒有影响 预防。拉凯健康科学项目 (RHSP) 和麦克雷雷大学公共卫生学院 乌干达 MakSPH 与约翰·霍普金斯大学 (JHU) 合作已超过 20 年。我们进行了 两次 MMC 试验、试验后监测、MMC 服务评估以及 MMC 程序评估， 包括新的 MMC 设备。我们还合作进行了包皮的免疫学和病毒学研究 组织和生殖器微生物组。该合作已通过以下方式培训了 50 多名学位和非学位学生 福格蒂国际中心（FIC）奖项。我们建议继续这些培训工作并提供 乌干达科学家专注于 MMC 相关研究的研究机会和职业发展， 既因为 MMC 对艾滋病毒预防至关重要，也因为 MMC 相关研究为 广泛的协同和跨学科研究。具体来说，在约翰霍普金斯大学，我们建议培养一名博士 生殖器免疫学、病毒学和分子微生物学候选人，以及 5 名 MPH/MHS 候选人 实施科学、流行病学和生物统计学、项目评估和混合方法研究。我们 将在 MakSPH 培养 2 名博士生，使用既定的“三明治”博士，允许短期学习 学员来到约翰霍普金斯大学接受高级课程和指导。在乌干达，我们将支持 5 名硕士和 3 名 MakSPH 和其他乌干达大学的学士学位学员和 18 名文凭/证书学员。 美国项目主任 (PD) Ronald Gray 博士、约翰霍普金斯大学流行病学教授和乌干达重点 外国合作者是 MakSPH 教授 David Serwadda 博士。培训将由培训部门监督 乌干达和美国的咨询委员会。 RHSP/MakSPH 将提供进入 Rakai 研究领域的机会 体验式培训场地、培训相关研究的数据和样本，以及丰富稳定的环境 职业发展。该计划建立在先前的培训和研究的基础上，以确保长期可持续性 RHSP 和 MakSPH 作为世界一流的艾滋病毒研究机构的领导地位。

Project Summary/ Abstract Medical male circumcision (MMC) reduces HIV acquisition in men, and viral STIs in men and women. However, uptake of MMC in many African countries is less than expected and has disproportionately been among younger, lower risk men. There is an urgent need for implementation science incorporating qualitative/quantitative mixed methods research to increase the demand for MMC, particularly among higher risk men; to increase the efficiency of MMC services using MC devices, task shifting/sharing and mobile MMC camps; and to conduct population-level monitoring of coverage and impact. At the basic science level, foreskins collected during MC provide unique access to genital mucosa for study of the virologic, immunologic and host genetic factors associated with vulnerability to or protection from HIV, with implications for HIV prevention. The Rakai Health Sciences Program (RHSP) and Makerere University School of Public Health (MakSPH) in Uganda have collaborated with Johns Hopkins University (JHU) for over 20 years. We conducted two trials of MMC, post-trial surveillance, evaluation of MMC services, and assessment of MMC procedures, including new MMC devices. We have also collaborated on immunologic and virologic studies of foreskin tissues and the genital microbiome. The collaboration has trained over 50 degree and non-degree students via Fogarty International Center (FIC) awards. We propose to continue these training efforts and to provide research opportunities and career development for Ugandan scientists focusing on MMC related research, both because MMC is vital to HIV prevention, and because MMC-related research provides an opportunity for a wide range of synergistic and interdisciplinary studies. Specifically, at JHU we propose to train one PhD candidate in genital immunology, virology and molecular microbiology, and 5 MPH/MHS candidates in implementation science, epidemiology and biostatistics, program evaluation and mixed methods research. We will train 2 doctoral students at MakSPH, using an established "sandwich" PhD which allows short-term trainees to come to JHU for advanced courses and mentoring. In Uganda, we will support 5 Masters and 3 Bachelors degree trainees, and 18 diploma/certificate trainees at MakSPH and other Ugandan universities. The U.S. Program Director (PD) Dr. Ronald Gray, Professor of Epidemiology at the JHU and the Ugandan Key Foreign Collaborator is Dr. David Serwadda, Professor, at MakSPH. Training will be overseen by Training Advisory Committees in Uganda and the US. RHSP/MakSPH will provide access to the Rakai research field site for experiential training, data and samples for training-related research, and a rich stable environment for career development. The program builds on prior training and research to ensure the long-term sustainability and leadership of RHSP and MakSPH as world class HIV research institutions.